儿童不同程度分泌性中耳炎的治疗效果分析

Effect analysis of children with different levels of secretory otitis media treatment

目的研究儿童分泌性中耳炎的治疗方法及疗效,为其治疗方案提供选择依据。方法对2009年1月～2010年6月本院确诊的262例分泌性中耳炎患儿进行治疗,先予保守治疗3个月,无效患儿再选择手术治疗64例。不伴腺样体肥大行鼓膜置管术12例;伴腺样体肥大且单纯声导抗测试异常患儿,行腺样体切除术22例;伴腺样体肥大且声导抗测试异常、听力损失者,行腺样体切除+鼓膜置管术30例。记录每组手术前后的纯音听阈值,随诊观察6个月以上,对结果进行分析。结果第1、3组术后1周、1个月、6个月与术前比较各频率气导听阈明显下降(P<0.001)。而第2组手术后1周、1个月的平均听阈较术前明显下降(P<0.05),术后半年与术前比较差异无统计学意义(P>0.05)。结论分泌性中耳炎患儿有3/4可通过保守治疗治愈,1/4患儿需要手术干预。不伴腺样体肥大的分泌性中耳炎可行鼓膜置管术;伴腺样体肥大的分泌性中耳炎患儿可行腺样体切除术;对疗程长,听力下降明显的伴腺样体肥大的分泌性中耳炎患儿可行腺样体切除同时行鼓膜置管术为宜。对儿童分泌性中耳炎的术式选择应该个体化。

Objective To study the treatment methods of the different levels of pediatric otitis media with effusion （OME） cases for better treatment methods in such cases. Methods Two hundred and sixty-two OME confirmed cases who then re- ceived conservative treatments and followed up for 3 months from January 2009 to June 2010. 64 cases chose surgically treatment because of 3 months conservative treatment failed. 12 cases without adenoidal hypertrophy were treated with tym- panostomy tubes. 22 cases with adenoidal hypertrophy and acoustic impedance tested abnormal in children were treated with adenoidectomy. 30 cases with adenoidal hypertrophy, acoustic impedance tested abnormal and hearing loss were treat- ed with adenoidectomy and tympanostomy tubes. The threshold of pure tone hearing were recorded before and after surgery. Follow-up observations 6 months above, the results were analyzed. Results The 1, 3 group after 1 weeks, 1 months, 6 months compared with the preoperative, the frequency of air conduction hearing threshold decreased significantly （P 〈 0.001）. The sec- ond group 1 week, 1 months after surgery, the average hearing threshold compared with the preoperative was significantly decreased （P 〈 0.05）, after 6 months compared with the preoperative difference was not statistically significant （P 〉 0.05）. Conclusion Three-quarters of pediatric OME cases can well treated with conservative treatments. The other one quarter OME cases need surgically treated. Patient without adenoidal hypertrophy can well-treated with tympanostomy tubes. Pa- tient with adenoidal hypertrophy can well-treated with adenoideetomy. On the long course of treatment, Significant hearing loss associated with otitis media with effusion in children with adenoidal hypertrophy, adenoidectomy and tympanostomy tubes are suitble surgical treatments for them. Surgical management for OME in children should be individualized.